Previous objective studies of the use of chronic care facilities by this community's health planning agency have shown that just over 40 percent of the patients in such settings were at an inappropriate level of care. These results led, in the first two years of this project, (a team approach of physician and public health nurse clinician with a social worker as needed) to the development and testing of a comprehensive evaluation and placement service, whose aim is to achieve more appropriate placement of elderly and chronically ill persons who need long-term care (including maintenance at home with supporting services whenever possible). Results to date demonstrate that such a service can improve appropriateness of placement to 85 percent or better (based, as is the original studies, on judgment of independent evaluation teams); that significant savings are likely through more appropriate placement, as well as better patient care; and that the medical component of the evaluation is essential - 57 percent of patients have required further diagnosis and treatment before placement recommendations could be made. The general goals of this proposed continuation project are to demonstrate the feasibility of expanding this service to most of the persons (more than 2,000 per year) in an urban county, who apply for long-term care, and to develop a similar service in a rural county with the aim of continuing to achieve a high degree of appropriateness of placement as judged independently. Other aims are to reduce the cost of long-term care; to develop funding mechanisms; to make such a service self-sustaining; to develop criteria for operations of such a unit and for making placement determinations; and to assist in providing definitive data for planning of services and facilities for the elderly and chronically ill. The results of this investigation should provide guidelines for the establishment of similar services throughout the country.